1. Articles from Justis P. Ehlers

    1-24 of 58 1 2 3 »
    1. Intraoperative OCT-Assisted Retinal Detachment Repair in the DISCOVER Study: Impact and Outcomes

      Intraoperative OCT-Assisted Retinal Detachment Repair in the DISCOVER Study: Impact and Outcomes

      Purpose The purpose of this study is to evaluate intraoperative OCT (iOCT) utility and outcomes during retinal detachment (RD) repair. Design The DISCOVER intraoperative OCT study is a prospective IRB-approved study. Subjects Subjects in the DISCOVER study undergoing surgical repair for RD. Methods This was a post-hoc analysis of eyes in the DISCOVER study undergoing surgical repair for retinal detachments. Inclusion criteria included iOCT following perfluorocarbon liquid (PFO) placement and at least 6 months follow-up. Exclusion criteria included severe retinal pathology unrelated to RD. Surgeons completed standardized questionnaires after each case evaluating the iOCT instrument’s utility. Functional and surgical ...

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    2. Advances In Intraoperative OCT

      Advances In Intraoperative OCT

      Over the past decade, there have been major advances in the field of intraoperative optical coherence tomography. From the development of the portable OCT probe to the first microscope-integrated system, intraoperative OCT has evolved from a research idea to a clinically viable technology. Advances such as heads-up visualization and microscope-integration, as well as the results from large clinical studies, have pushed the field forward. While the feasibility and potential utility of intraoperative optical coherence tomography has been demonstrated both in clinical studies and in real-world usage, several areas of enhancement are needed to enable iOCT to be part of a ...

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    3. Intraoperative Optical Coherence Tomography-Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study: First 100 Cases

      Intraoperative Optical Coherence Tomography-Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study: First 100 Cases

      Purpose Intraoperative optical coherence tomography (iOCT) may facilitate successful transition to descemet membrane endothelial keratoplasty (DMEK) surgery via improved efficiency of tissue orientation. The purpose of this study is to report a large consecutive series of iOCT-assisted DMEK, inclusive of all learning curve cases. Design Prospective consecutive case series. Methods The Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) study is a single-site, multi-surgeon, IRB-approved investigational device prospective study. The first 100 consecutive iOCT-assisted DMEK surgeries performed by one attending corneal surgeon (JMG) and six novice surgeons (cornea ...

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    4. Optical coherence tomography angiography characteristics of choroidal neovascularization requiring varied dosing frequencies in treat-and-extend management: An analysis of the AVATAR study

      Optical coherence tomography angiography characteristics of choroidal neovascularization requiring varied dosing frequencies in treat-and-extend management: An analysis of the AVATAR study

      Purpose To evaluate optical coherence tomography angiography (OCTA) characteristics of choroidal neovascularization (CNV) in eyes requiring different treatment frequency of anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (NVAMD). Design Prospective observational case series. Methods Subjects who had undergone anti-VEGF treatment for NVAMD in the AVATAR study were subdivided into 3 groups depending on required anti-VEGF dosing: (i) treat-and-extend requiring every 4–6 weeks dosing (TEq4-6w), (ii) treat-and-extend requiring every 7–12 weeks dosing (TEq7-12w), (iii) eyes not requiring injection within last 12 months (PRN >12mo). OCTA images were evaluated for the morphological characteristics of CNV and ...

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    5. IMPACT OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY REVIEW STRATEGY ON DETECTION OF CHOROIDAL NEOVASCULARIZATION

      IMPACT OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY REVIEW STRATEGY ON DETECTION OF CHOROIDAL NEOVASCULARIZATION

      Purpose: To compare optical coherence tomography angiography ( OCTA ) review strategies for optimizing choroidal neovascularization ( CNV ) detection . Methods: Eyes with CNV in the differential diagnosis were imaged with the Avanti RTVue XR HD (Optovue, Fremont, CA). Three modalities of review for CNV presence were used in each case: a single report generated using automated segmentation within Avanti software; a continuous slab descent video OCTA export; and a manual segmentation approach using cross-sectional OCT with decorrelation signal overlay. Scans were reviewed by two masked expert reviewers; a third reviewer was used for discrepancies. Results: The study included 421 eyes, and 350 eyes ...

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    6. Predictive Model for Macular Hole Closure Speed: Insights From Intraoperative Optical Coherence Tomography

      Predictive Model for Macular Hole Closure Speed: Insights From Intraoperative Optical Coherence Tomography

      Purpose : To establish a predictive model of macular hole (MH) closure speed. Methods : This study was a post hoc analysis of eyes that underwent full-thickness MH repair in the prospective PIONEER intraoperative optical coherence tomography (iOCT) study. The Bioptigen SDOIS system was used for iOCT imaging. All patients underwent standard small-gauge vitrectomy with internal limiting membrane (ILM) peeling, gas tamponade, and postoperative facedown positioning. Before vitrectomy and after ILM peeling, various quantitative OCT measures related to MH were obtained, including MH geometry alterations and outer retinal features. Trans-gas OCT was performed on postoperative day 1 to evaluate MH closure. Univariate ...

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    7. Intraoperative OCT Features and Postoperative Ellipsoid Mapping in Primary Macula-Involving Retinal Detachments from the PIONEER Study

      Intraoperative OCT Features and Postoperative Ellipsoid Mapping in Primary Macula-Involving Retinal Detachments from the PIONEER Study

      Purpose Intraoperative OCT (iOCT) has enabled visualization of subtle structural details during surgical interventions, including retinal detachment repair. The purpose of this study is to evaluate iOCT findings during retinal detachment repair and assess their impact on anatomic and functional outcomes, including outer retinal integrity. Design The PIONEER iOCT study is a prospective cohort IRB-approved study. Subjects Subjects in the PIONEER study undergoing surgical repair for primary macula-involving retinal detachment. Methods This was a post-hoc analysis of all eyes in the PIONEER study undergoing surgical repair with primary macula-involving retinal detachments. Inclusion criteria included iOCT following perfluorocarbon liquid (PFO) placement ...

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    8. Clinic evaluation via outer retinal layer assessment

      Clinic evaluation via outer retinal layer assessment

      Systems and methods are provided for evaluating an eye of a patient from a set of OCT data. A layer segmentation component is configured to identify and segment a plurality of retinal layers within the set of OCT data. The plurality of layers include a layer of interest. A mapping component is configured to generate at least one of an en face representation of the layer of interest and a three-dimensional reconstruction of the layer of interest from the segmented plurality of layers. A parameter generator is configured to derive at least one parameter, representing a thickness of the layer ...

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    9. Outer Retinal Assessment Using Spectral-Domain Optical Coherence Tomography in Patients With Alzheimer's and Parkinson's Disease

      Outer Retinal Assessment Using Spectral-Domain Optical Coherence Tomography in Patients With Alzheimer's and Parkinson's Disease

      Purpose : To investigate outer retinal parameters among patients with various chronic neurodegenerative disorders by using spectral-domain coherence tomography (OCT) in a prospective cross-sectional cohort study. Methods : A total of 132 participants were enrolled following a comprehensive diagnostic evaluation with neurologic, neuropsychology, and magnetic resonance imaging volumetric evaluations. Participants were 50 years or older, either diagnosed with Alzheimer's disease (AD) dementia, amnestic mild cognitive impairment (MCI), non-AD dementia, Parkinson's disease (PD), or age- and sex-matched controls. All participants underwent a macular cube scan for both eyes by using the Cirrus 4000 HD-OCT (Zeiss, Oberkochen, Germany). The OCT image with ...

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    10. Choriocapillaris and retinal vascular plexus density of diabetic eyes using split-spectrum amplitude decorrelation spectral-domain optical coherence tomography angiography

      Choriocapillaris and retinal vascular plexus density of diabetic eyes using split-spectrum amplitude decorrelation spectral-domain optical coherence tomography angiography

      Background/aims Split-spectrum amplitude decorrelation angiography for spectral-domain optical coherence tomography has enabled detailed, non-invasive assessment of vascular flow. This study evaluates choriocapillaris and retinal capillary perfusion density (CPD) in diabetic eyes using optical coherence tomography angiography (OCTA). Methods Records of 136 eyes that underwent OCTA imaging at a single institution were reviewed. Eyes were grouped as non-diabetic controls (37 eyes), patients with diabetes mellitus (DM) without diabetic retinopathy (DM without DR, 31 eyes), non-proliferative diabetic retinopathy (NPDR, 41 eyes) and proliferative diabetic retinopathy (PDR, 27 eyes). Quantitative CPD analyses were performed on OCTA images for assessing perfusion density of ...

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    11. The DISCOVER Study 3-Year Results

      The DISCOVER Study 3-Year Results

      Purpose To report the 3-year assessment of feasibility and usefulness of microscope-integrated intraoperative OCT (iOCT) during ophthalmic surgery. Design Prospective, consecutive case series. Participants Adult participants undergoing incisional ophthalmic surgery with iOCT imaging who consented to be enrolled in the Determination of Feasibility of Intraoperative Spectral-Domain Microscope Combined/Integrated OCT Visualization during En Face Retinal and Ophthalmic Surgery (DISCOVER) study. Methods The DISCOVER study is a single-site, multisurgeon, institutional review board-approved investigational device prospective study. Participants included patients undergoing anterior or posterior segment surgery who underwent iOCT imaging with 1 of 3 prototype microscope-integrated iOCT systems (i.e., Zeiss Rescan ...

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    12. Comparison of OCT Angiography Review Strategies to Identify Vascular Abnormalities in the AVATAR Study

      Comparison of OCT Angiography Review Strategies to Identify Vascular Abnormalities in the AVATAR Study

      Purpose To compare review strategies for OCT angiography (OCTA) for multiple disease features found in common diseases of the choroid and retina. Design Prospective, observational study. Participants Patients with macular disease undergoing routine spectral-domain OCT. Methods Eyes were imaged with the Avanti RTVue XR HD (Optovue, Fremont, CA), and the split-spectrum amplitude decorrelation angiography algorithm software was used for OCTA performance. Scans were reviewed by 2 masked expert reviewers. A third masked reviewer was used in cases of reviewer disagreement. A single report using automated segmentation within the Avanti software (Optovue, Fremont, CA) to represent the superficial retina capillary plexus ...

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    13. Intraoperative Optical Coherence Tomography–Assisted Chorioretinal Biopsy in the DISCOVER Study

      Intraoperative Optical Coherence Tomography–Assisted Chorioretinal Biopsy in the DISCOVER Study

      Infiltrative conditions such as lymphoproliferative disorders, amyloidosis, and autoimmune and infectious disorders can overlap in their ophthalmic clinical presentation. Malignancies and other infiltrative disease processes can masquerade as ocular inflammatory conditions. To obtain a definitive clinical diagnosis, a biopsy of the choroid and/or retina may be warranted. When conducting biopsy of intraocular structures, preoperative understanding of retinal microanatomy frequently informs surgical planning. Although office-based, clinical table-top optical coherence tomography (OCT) units have been used for imaging lesions preoperatively, static office-based testing and limited peripheral visualization may diminish the role for using OCT for identification of the optimal biopsy site ...

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    14. Intraoperative optical coherence tomography-compatible surgical instruments for real-time image-guided ophthalmic surgery

      Intraoperative optical coherence tomography-compatible surgical instruments for real-time image-guided ophthalmic surgery

      Intraoperative optical coherence tomography (OCT) is a potentially transformational technology that is now commercially available to ophthalmic surgeons. Currently, the use of the technology is primarily limited to a ‘stop and image’ approach due to the lack of OCT compatibility with surgical instrumentation. In this report, we describe multiple OCT-compatible surgical instruments that were developed for various surgical needs, based on previous evaluation of potential surgical materials for optical features and physical properties. OCT-compatible instrumentation included two membrane scrapers, a surgical pick and vitreoretinal forceps. Imaging during in vitro and ex vivo-simulated surgical procedures demonstrated excellent visualisation of the instrument ...

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    15. Outcomes of Intraoperative OCT–Assisted Epiretinal Membrane Surgery from the PIONEER Study

      Outcomes of Intraoperative OCT–Assisted Epiretinal Membrane Surgery from the PIONEER Study

      Purpose To assess the retinal architecture changes that occur during epiretinal membrane (ERM) surgery, utilizing intraoperative OCT ( i OCT). Design Prospective multisurgeon single-center study. Subjects Subjects from the PIONEER i OCT study who underwent surgical intervention for management of ERM. Methods All subjects underwent vitrectomy with ERM peeling with optional internal limiting membrane (ILM) peeling. Preoperative, intraoperative, and postoperative quantitative and qualitative OCT assessments were performed. Clinical characteristics including visual acuity outcomes, central subfield thickness, and complications, including ERM recurrence and need for reoperation, were assessed at 3, 6, and 12 months after surgery for membrane peeling, as available. Main ...

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    16. Microscope-Integrated OCT Feasibility and Utility With the EnFocus System in the DISCOVER Study

      Microscope-Integrated OCT Feasibility and Utility With the EnFocus System in the DISCOVER Study

      BACKGROUND AND OBJECTIVE: To evaluate the feasibility and utility of a novel microscope-integrated intraoperative optical coherence tomography (OCT) system. PATIENTS AND METHODS: The DISCOVER study is an investigational device study evaluating microscope-integrated intraoperative OCT systems for ophthalmic surgery. This report focuses on subjects imaged with the EnFocus prototype system (Leica Microsystems/Bioptigen, Morrisville, NC). OCT was performed at surgeon-directed milestones. Surgeons completed a questionnaire after each case to evaluate the impact of OCT on intraoperative management. RESULTS: Fifty eyes underwent imaging with the EnFocus system. Successful imaging was obtained in 46 of 50 eyes (92%). In eight cases (16%), surgical ...

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    17. Optical Coherence Tomography Features in Diabetic Macular Edema and the Impact on Anti-VEGF Response

      Optical Coherence Tomography Features in Diabetic Macular Edema and the Impact on Anti-VEGF Response

      BACKGROUND AND OBJECTIVE: To assess the relationship between spectral-domain optical coherence tomography (SD-OCT) features and functional outcomes for diabetic macular edema (DME) undergoing treatment with intravitreal bevacizumab (Avastin; Genentech, South San Francisco, CA). PATIENTS AND METHODS: Institutional review board-approved, retrospective, consecutive case series of eyes receiving intravitreal bevacizumab (1.25 mg) for DME. SD-OCT features were evaluated and correlated with functional response to anti-vascular endothelial growth factor (VEGF) therapy. RESULTS: One hundred fifty-nine eyes of 159 subjects were included in this study. Mean visual acuity improved from 20/76 to 20/58. The proportion of eyes with 20/40 or ...

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    18. Intraoperative Interface Fluid Dynamics and Clinical Outcomes for Intraoperative OCT-Assisted DSAEK from the Pioneer Study

      Intraoperative Interface Fluid Dynamics and Clinical Outcomes for Intraoperative OCT-Assisted DSAEK from the Pioneer Study

      Purpose To correlate intraoperative interface fluid dynamics during Descemet stripping automated endothelial keratoplasty (DSAEK) surgery using intraoperative optical coherence tomography (iOCT) in the PIONEER (Prospective Intraoperative and Perioperative Ophthalmic ImagiNg with Optical CohEncE TomogRaphy) study with postoperative outcomes. Design Prospective consecutive, interventional, comparative case series Participants One hundred and seventy-eight eyes of 173 patients undergoing DSAEK from the Cole Eye Institute, Cleveland, USA. Methods Eyes that underwent DSAEK between October 2011 and March 2014 from the PIONEER intraoperative and perioperative OCT study were included. An automated interface fluid segmentation algorithm evaluated intraoperative dynamics of interface fluid before and after surgical ...

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    19. Clinical utility of intraoperative optical coherence tomography

      Clinical utility of intraoperative optical coherence tomography

      Purpose of review: To explore the clinical utility of intraoperative optical coherence tomography (iOCT) for the management of vitreoretinal conditions. Recent findings: The role of iOCT in guiding surgical decision-making and surgical manipulations during vitreoretinal procedures has been evaluated by multiple studies. This imaging modality is emerging as a valuable asset during procedures for vitreoretinal interface disorders, retinal detachments, submacular surgeries and therapeutics, and in pediatric conditions such as retinopathy of prematurity. iOCT allows the surgeon to assess completion of surgical goals and to directly monitor the architectural impact of instrument-tissue interactions that may correlate with eventual prognosis. The technology ...

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      Mentions: Justis P. Ehlers
    20. Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study

      Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study

      Purpose : To assess retinal architectural alterations that occur following membrane peeling procedures and the impact of peel technique on these alterations utilizing intraoperative optical coherence tomography ( i OCT). Methods : This is a subanalysis of the prospective PIONEER i OCT study of eyes undergoing a membrane peeling for a vitreomacular interface (VMI) disorder. Intraoperative scanning was performed with a microscope-mounted OCT system. Macroarchitectural alterations (e.g., full-thickness retinal elevations) and microarchitectural alterations (e.g., relative layer thickness alterations) were analyzed. Video/ i OCT correlation was performed to identify instrument-tissue manipulations resulting in macroarchitectural alterations. Results : One hundred sixty-three eyes were included ...

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    21. Optical Coherence Tomography Angiography of Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy

      Optical Coherence Tomography Angiography of Acute Macular Neuroretinopathy and Paracentral Acute Middle Maculopathy

      This case report describes acute macular neuroretinopathy/paracentral acute middle maculopathy in a pregnant woman. Acute macular neuroretinopathy (AMN) has been characterized as wedge-shaped superficial retinal defects in the macula, resulting in paracentral scotomas. It has been associated with vasoconstrictors and sympathomimetics. 1 In 2013, paracentral acute middle maculopathy (PAMM) was described as an AMN variant, seen as a hyperreflective band involving the middle retinal layers on spectral-domain optical coherence tomography (SD-OCT). 1 Type 1 PAMM lesions involve layers above the outer plexiform layer (OPL), reflecting superficial or intermediate capillary plexus occlusion; type 2 lesions involve layers below the OPL ...

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    22. Intraoperative OCT-Assisted Subretinal Perfluorocarbon Liquid Removal in the DISCOVER Study

      Intraoperative OCT-Assisted Subretinal Perfluorocarbon Liquid Removal in the DISCOVER Study

      BACKGROUND AND OBJECTIVE: To assess the role for intraoperative optical coherence tomography (iOCT) during subretinal perfluoro-n-octane (PFO) removal and evaluate it as an assistive technique during surgical maneuvers. MATERIALS AND METHODS: DISCOVER is a prospective study examining microscope-integrated iOCT systems in ophthalmic surgery. The authors report a technique utilizing iOCT guidance and feedback for surgical removal of chronic subretinal PFO. RESULTS: In this technique, real-time iOCT feedback successfully guided surgical maneuvers to facilitate removal of PFO. Due to the chronicity of the PFO, it was loculated and resistant to multiple maneuvers. Utilizing real-time feedback, additional maneuvers were attempted with feedback ...

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    1-24 of 58 1 2 3 »
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